Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Reimagining the Surgical Safety Checklist Through a Pediatric Lens.
Wigen R, Squires K, Pilkington M … +4 more , Puligandla P, Gonzalez R, Henry M, Brindle M
J Pediatr Surg · 2026 Jul · PMID 42392257 · Publisher ↗
PURPOSE: This study, endorsed by CAPS and APSA leadership, aimed to gather perspectives from North American pediatric surgeons on how the Surgical Safety Checklist (SSC) can be optimized for the contemporary pediatric pe...
PURPOSE: This study, endorsed by CAPS and APSA leadership, aimed to gather perspectives from North American pediatric surgeons on how the Surgical Safety Checklist (SSC) can be optimized for the contemporary pediatric perioperative population. METHODS: This mixed-methods study included a North American survey of pediatric surgeons engaged in quality and safety, followed by a structured convening with focus groups and large-group discussion. Facilitated conversations underwent deductive thematic analysis. Using a sequential explanatory approach, we explored user perspectives on how a pediatric SSC could be optimized in its content, format, and implementation. RESULTS: Sixty-eight surgeons responded to the survey and 30 participated in the convening, representing 7 provinces and 15 states. Survey respondents emphasized the role of the SSC as a communication tool to improve patient safety. The highest-ranked priorities for a redeveloped SSC were preventing wrong surgery (96%) and improving team communication (93%). Free-text responses identified additional opportunities for SSC refinement. Convening participants suggested the removal of redundant items (e.g., sterility confirmation), addition of pediatric-specific elements, such as patient weight and hypothermia risk, and procedure-based modifiability. Implementation strategies included incorporating a morning team huddle, addressing family needs through defined parent roles, and strengthening safety culture through meaningful audits and improved checklist design, including digitization. Participants also emphasized the importance of adapting SSCs to site-specific contexts. CONCLUSION: These findings identify opportunities to enhance perioperative safety and re-engage pediatric surgical teams through pediatric SSC reimplementation.
Bridge Fixation Provides Consistent Implant Stability Across Surgical Techniques: A Multicenter Study.
Toselli L, Bellia-Munzón G, Vega C … +9 more , Giacosa F, Sanjurjo D, Pintos G, Elmo G, Fernández M, Siscar N, Nicolás M, Carmona A, Martínez-Ferro M
J Pediatr Surg · 2026 Jul · PMID 42392256 · Publisher ↗
BACKGROUND/PURPOSE: Bar rotation remains a relevant complication following minimally invasive repair of pectus excavatum (MIRPE), with potential need for reoperation and risk of severe intrathoracic injury. Bridge fixati...
BACKGROUND/PURPOSE: Bar rotation remains a relevant complication following minimally invasive repair of pectus excavatum (MIRPE), with potential need for reoperation and risk of severe intrathoracic injury. Bridge fixation has been proposed as a stabilization strategy to prevent implant rotation; however, evidence supporting its effectiveness remains limited. This study aimed to evaluate the stability of bridge fixation in a large multicenter cohort. METHODS: A retrospective multicenter study was conducted including patients undergoing chest wall repair with intrathoracic implants stabilized using bilateral lateral bridges across five centers in Buenos Aires, Argentina, between November 2015 and November 2025. Demographic characteristics, surgical technique, implant configuration, use of cryoanalgesia, postoperative length of stay, complications, and implant removal were collected. The primary outcome was reoperation due to implant rotation. RESULTS: A total of 1,821 intrathoracic implants were placed in 710 patients. Median age was 15.0 years (IQR 14.0; 17.0; range 9-52), with 174 patients (24.6%) older than 17 years. Most procedures were MIRPE (92.5%), followed by the sandwich technique (3.9%) and hybrid techniques (3.5%). Two bars were used in 44.4% of patients and three bars in 54.9%. Crossed bars were used in 31.0% of cases, and cryoanalgesia was used in 68.6% of patients. Implant removal was performed in 52.0% of patients at a median of 24.0 months (IQR 23.0; 25.0). Overall, postoperative complications requiring reoperations occurred in 6.1% of patients. No implant rotation requiring reoperation was observed among the 1,821 implants during the study period. CONCLUSIONS: In this large multicenter series, bridge fixation was associated with complete prevention of implant rotation requiring reoperation across a wide range of surgical techniques, implant configurations, and patient characteristics. These findings support the reliability of the bridge technique to prevent implant rotation. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: IV.
National Benchmarks for Penetrating Head Injury in U.S. Children and Adolescents: Mechanism, Intent, and Disparities in Mortality.
Mina AS, Chen JW, Wolf K … +2 more , Vogel AM, Pryor HI
J Pediatr Surg · 2026 Jul · PMID 42392255 · Publisher ↗
PURPOSE: To establish contemporary national benchmarks for penetrating head injury (PPHI) in children and adolescents by characterizing its epidemiology, age, race/ethnicity, mechanism, and intent, and to identify indepe...
PURPOSE: To establish contemporary national benchmarks for penetrating head injury (PPHI) in children and adolescents by characterizing its epidemiology, age, race/ethnicity, mechanism, and intent, and to identify independent predictors of mortality, in order to inform age- and mechanism-specific prevention. METHODS: Retrospective cohort study of children and adolescents aged 1-17 years with PPHI in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database, 2019-2023. PPHI comprised firearm, cut/pierce, and animal-bite mechanisms with documented head-region involvement. Patients were stratified into four developmental age groups (1-4, 5-9, 10-14, 15-17 years). Outcomes included overall (emergency department and in-hospital) mortality, neurosurgical intervention, length of stay, and hospital-acquired infection (HAI). Animal bites were summarized as a separate descriptive subgroup; the multivariable mortality model was restricted to firearm and cut/pierce mechanisms, with a sensitivity analysis varying the head-injury severity threshold. RESULTS: Among 9,046 children and adolescents with PPHI, 73.8% were male and 49.9% were aged 15-17 years. Mechanism and intent shifted markedly with age: animal bites predominated among children aged 1-4 years (61.3% of that group), whereas firearms accounted for 88.2% of injuries in adolescents aged 15-17 years. Injuries were predominantly unintentional before age 10 (80.9%); self-inflicted injury peaked at ages 10-14 (21.1%); and assault predominated at ages 15-17 (63.4%). Overall mortality was 25.4% and rose from 12.2% in children aged 1-9 years to 31.3% in those aged 10-17 years. Firearms caused 6,199 injuries (68.5%) and 97.7% of all deaths. Independent predictors of mortality included firearm mechanism, self-inflicted intent, non-Hispanic Black race, lower Glasgow Coma Scale score, higher Injury Severity Score, and direct (non-transferred) arrival. CONCLUSION: PPHI in U.S. children and adolescents comprises three distinct epidemiologic phenotypes, animal bites in young children, self-inflicted firearm injury peaking in early adolescence, and firearm assault concentrated among older, predominantly non-Hispanic Black adolescents. Firearms drive nearly all mortality. These national benchmarks support tailored, phenotype-specific prevention rather than a single undifferentiated strategy.
Long-Term Growth and Neurodevelopmental Outcomes of a Standardized Gastroschisis Feeding Protocol: a retrospective cohort study.
Trivedi A, Singh S, Webb A … +1 more , Mehta B
J Pediatr Surg · 2026 Jul · PMID 42385792 · Publisher ↗
AIM: To evaluate the long-term impact of a standardized feeding protocol on growth and neurodevelopmental outcomes in neonates with simple gastroschisis. METHODS: A single-center, retrospective cohort study compared pre-...
AIM: To evaluate the long-term impact of a standardized feeding protocol on growth and neurodevelopmental outcomes in neonates with simple gastroschisis. METHODS: A single-center, retrospective cohort study compared pre- and post-feeding protocol outcomes for neonates with simple gastroschisis. Primary outcomes included anthropometric growth z-scores and neurodevelopmental assessment at three and twelve months. Secondary outcomes included neonatal intensive care unit length of stay and total parenteral nutrition duration. RESULTS: The study included 126 neonates admitted from January 2010 to June 2024, categorized into pre-protocol (n=55) and post-protocol (n=71) cohorts. In the multivariate linear regression analysis, the post-protocol group demonstrated significantly higher weight z-scores at 3 months (Beta = 0.64, 95% CI: 0.01 to 1.22; p=0.029), though this advantage was not sustained at 12 months. Neurodevelopmental assessment revealed no significant differences in cognitive or motor delays at 12 months. A transient reduction in language delay was observed at three months in the post-protocol group (7.1% vs 29.2%, adjusted OR 0.06; p=0.039), but this did not persist at one year. The protocol was associated with significantly reduced duration of total parenteral nutrition (455.9 hours vs 624.5 hours; p=0.009) and shorter length of stay (25.5 days vs 34.5 days; p=0.004). Attrition analysis showed no significant clinical differences despite higher post-protocol follow-up loss. CONCLUSION: Standardized feeding protocol significantly improved acute care efficiency by reducing hospital stay and reliance on total parenteral nutrition without compromising long-term growth trajectories or neurodevelopmental outcomes at one year of age. These findings confirm the safety of protocolized feeding for simple gastroschisis.
Economic Evaluation of Hirschsprung Disease Testing Strategies for Children with Medically-Refractory Chronic Constipation: A Cost-Effectiveness Analysis.
Obidike PC, Wanchek TN, Rialon KL … +2 more , King A, Cheng LS
J Pediatr Surg · 2026 Jul · PMID 42385791 · Publisher ↗
BACKGROUND: Early and accurate diagnosis of Hirschsprung disease (HSCR) prevents life-threatening complications, improves patient outcomes, and reduces healthcare utilization. Contrast enema (CE), anorectal manometry (AM...
BACKGROUND: Early and accurate diagnosis of Hirschsprung disease (HSCR) prevents life-threatening complications, improves patient outcomes, and reduces healthcare utilization. Contrast enema (CE), anorectal manometry (AMAN), and rectal biopsy (RB) are commonly used diagnostic tests, with RB being the gold standard. However, the most cost-effective initial diagnostic strategy remains unclear. METHODS: A decision-analytic model was used to compare CE-first, AMAN-first, and RB-first strategies for the evaluation of HSCR in children between 1-18 years of age presenting to specialty care for chronic constipation. The model incorporated diagnostic test performance, disease prevalence, and timing of surgical intervention over a three-year time horizon. Health utilities were estimated by mapping published Pediatric Quality of Life Inventory (PedsQL) scores to Child Health Utility 9D (CHU9D) values. Costs were averaged from institutional data. Willingness-to-pay (WTP) threshold was set at $50,000 per quality-adjusted life year (QALY). Outcomes included costs, QALYs, net monetary benefit (NMB), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed. RESULTS: CE-first emerged as the most cost-effective diagnostic strategy at a WTP of $50,000/QALY. RB-first provided greater effectiveness but at higher cost and was not cost-effective at the base-case threshold. RB-first became preferred when HSCR prevalence exceeded 29.2% and when the sensitivity of the test exceeded 97.8%. AMAN-first was least cost-effective and became preferred only when its sensitivity exceeded 90.5%. CONCLUSIONS: In the evaluation of children over 1 year of age presenting to specialty care with suspected HSCR, CE was the most cost-effective initial strategy in most scenarios. These findings provide economic insight to guide clinical decision-making for the diagnostic testing of HSCR.
Preoperative underweight is associated with a more complicated perioperative course and impairs recovery in Hirschsprung's disease: The pivotal role of weight-for-age z-score.
Zhang T, Luo W, Ying Y … +1 more , Jiang M
J Pediatr Surg · 2026 Jun · PMID 42379347 · Publisher ↗
BACKGROUND & AIMS: Low weight-for-age z-score (WAZ) is prevalent in children with Hirschsprung's disease (HD), yet its prognostic value for surgical outcomes is unclear. This study evaluated the impact of preoperative WA...
BACKGROUND & AIMS: Low weight-for-age z-score (WAZ) is prevalent in children with Hirschsprung's disease (HD), yet its prognostic value for surgical outcomes is unclear. This study evaluated the impact of preoperative WAZ on perioperative course complexity and postoperative recovery in children undergoing pull-through surgery. METHODS: A retrospective cohort study was conducted on 256 children aged ≤10 years who underwent pull-through. Patients were stratified by preoperative WAZ: underweight (WAZ < -2), at risk of underweight (-2 ≤ WAZ < -1), and well-nourished (WAZ ≥ -1). Demographic, clinical, and perioperative data were analyzed. RESULTS: Underweight patients showed a higher prevalence of total colonic aganglionosis (26.7%, P = 0.026), longer biopsy-to-treatment intervals (P < 0.001), and higher prior enterostomy rates (P < 0.001). They also had a higher laparotomy rate (36.6%, 11/30). This group experienced the longest postoperative hospital stay (median 13 days, P = 0.033), the highest Hirschsprung-associated enterocolitis (HAEC) readmission rate (46.7%, P = 0.039), and the highest postoperative parenteral nutrition (PN) use (60%). Multivariate analysis identified preoperative nutritional status (WAZ category) as the strongest independent predictor of PN duration. Relative to well-nourished patients, underweight and at-risk children required 10.22-fold (95% CI 4.16-25.13) and 4.34-fold (95% CI 1.70-11.10) longer PN support, respectively (both P < 0.01). CONCLUSION: Being underweight before pull-through is the strongest independent predictor of prolonged postoperative PN in children with HD. Lower WAZ was associated with more complex surgical pathways, delayed definitive surgery, higher laparotomy rates, longer hospital stays, and increased HAEC readmission risk.
Risk Factors for Postoperative Growth Retardation in Children with Biliary Atresia After Kasai Portoenterostomy: A Retrospective Analysis.
Tan X, Li G, Liu X … +9 more , Wang D, Zhao Y, Zhang Y, Sun D, Li S, Hua K, Gu Y, Liao J, Huang J
J Pediatr Surg · 2026 Jun · PMID 42372908 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the growth and development status of children with biliary atresia (BA) following Kasai portoenterostomy (KPE) and identify the risk factors associated with postoperative growth re...
OBJECTIVE: This study aimed to evaluate the growth and development status of children with biliary atresia (BA) following Kasai portoenterostomy (KPE) and identify the risk factors associated with postoperative growth retardation (GR). METHODS: A retrospective-observational study was conducted on 88 BA patients who underwent KPE at a single center between March 2016 and October 2024. Growth was assessed using Z-scores with GR defined as weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) or BMI-for-age Z-Score (BAZ)<-2SD at final follow-up. Clinical and biochemical variables were compared between GR and non-GR groups. Logistic regression with LASSO feature selection was used to explore variables associated with GR. RESULTS: The prevalence of GR was 15.9% (14/88) in the overall cohort and 17.7% (11/62) in native-liver survivors. GR was more common in children aged <2.5 years and >7.5 years. Lower weight at surgery, preoperative very low-density lipoprotein (VLDL), creatinine (Cr) and Prealbumin (PA), as well as early postoperative VLDL and Lactate dehydrogenase (LDH) levels were associated with GR. Early postoperative higher VLDL levels were the sole variable retained in the exploratory LASSO model (OR = 3.769, 95% CI: 1.608-11.199, p < 0.05), with an optimal cut-off value of 0.45 mmol/L. Dynamic biochemical analysis revealed distinct metabolic profiles in the GR group, including creatine kinase (CK), uric acid (UA) and albumin (ALB) postoperatively. CONCLUSION: Early postoperative higher VLDL levels were associated with GR in BA patients and with reduced muscle-related markers, suggesting a distinct metabolic profile. Monitoring early postoperative VLDL may help identify children who could benefit from earlier nutritional assessment.
The potential role of Daraxonrasib (RMC-6236) in relapsed neuroblastoma patients and the urgent need for preclinical investigations.
Gungormez EK, Sair O, Aydogdu H … +4 more , Pederiva F, Zorba Yildiz AP, Asir F, Azizoglu M
J Pediatr Surg · 2026 Jun · PMID 42372907 · Publisher ↗
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Penetrating pediatric trauma in the Netherlands: findings from the Dutch National Trauma Registry, 2015-2023.
Sanders FRK, Spiering DD, Buck D … +5 more , Backes M, Brouwers L, Timmermans L, Nelen SD, Pediatric Trauma Consortium Nijmegen
J Pediatr Surg · 2026 Jun · PMID 42372906 · Publisher ↗
BACKGROUND: According to the media, penetrating trauma and more specifically knife/firearm incidents are increasing in Europe over the past years. However, studies on incidence and trends are limited. This study aimed to...
BACKGROUND: According to the media, penetrating trauma and more specifically knife/firearm incidents are increasing in Europe over the past years. However, studies on incidence and trends are limited. This study aimed to describe incidence, trends, and outcome of penetrating pediatric trauma in The Netherlands. METHODS: A national database of prospectively collected data on children (<18 y/o) with traumatic injury admitted to the hospital was used to investigate penetrating trauma between 2015-2023. Primary outcomes were incidence and trends in frequency of penetrating trauma. Secondary outcomes included injury mechanism, morbidity (e.g. Glasgow Outcome Scale, length of stay) and mortality. RESULTS: Of 727 patients, 80% were male and the median age was 14 years. There was a significant increase in firearm injuries during the measured time period. There was no increase in general incidence of hospitalized penetrating injury, with the exception of 2021 when there was a significant rise in general penetrating/knife related injury. Moreover, the proportion of non-domestic violence-related incidents increased, whereas domestic incidents became less frequent. The majority (70%) were initially transferred to the observational ward, but 17% went straight to the operating room. Median length of stay was 2 days and 13% spent at least one day in an Intensive/Medium Care Unit. At discharge, 56% still had moderate or severe disability, measured by the Glasgow Outcome Scale (4 or less) and 1% (n=9) died during hospitalization. CONCLUSION: Only a small part of traumatic injuries in children is penetrating and no increase was found in time, except during the COVID pandemic, but consequences may be severe. Firearm incidents and non-domestic violence related crime seem to increase, which is a worrying development.
Letter to the editor: The Titanic Index for determining the number of bars needed for pectus repair.
Notrica DM, Jaroszewski DE, McMahon LE
J Pediatr Surg · 2026 Jun · PMID 42364871 · Publisher ↗
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HEALTH-RELATED QUALITY OF LIFE FOLLOWING THORACOSCOPIC REPAIR IN CHILDREN WITH LONG-GAP ESOPHAGEAL ATRESIA.
Rozensztrauch A, Śmigiel R, Borselle D … +4 more , Gerus S, Toczewski K, Blom MD, Patkowski D
J Pediatr Surg · 2026 Jun · PMID 42349546 · Publisher ↗
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ECMO cannulation techniques in children: heterogeneous and often complicated.
Moratilla-Lapeña L, Sarmiento MDC, Madurga A … +7 more , Lopez-Canelada M, Rey J, Velasco I, De La Torre C, Burgos P, Encinas JL, Hernandez-Oliveros F
J Pediatr Surg · 2026 Jun · PMID 42349545 · Publisher ↗
INTRODUCTION: Indications for ECMO are increasing, but standardized cannulation guidelines are lacking. This study aimed to describe complications and variability in management. METHODS: A single-center retrospective rev...
INTRODUCTION: Indications for ECMO are increasing, but standardized cannulation guidelines are lacking. This study aimed to describe complications and variability in management. METHODS: A single-center retrospective review of children undergoing cervical ECMO (2016-2023). Data included demographics, ECMO technique, cannula size, complications (ELSO classification), mortality and follow-up. Surgeon specialty [pediatric (PS) or cardiothoracic (CS)] and cannula fixation method (ligation vs. non-ligation) were recorded. RESULTS: Twenty-seven patients underwent ECMO, mainly for congenital diaphragmatic hernia (37%). All CS used non-ligation fixation (8/27), while PS used ligation fixation (19/27). Complications occurred in 74% of patients, predominantly mechanical (52%). PS cases had more cannula malposition and surgical site bleeding. Bleeding requiring intervention occurred in two patients per group. All patients with a 6 Fr arterial cannula died from hemolysis or pump failure. At decannulation, CS repaired both vessels, whereas PS repaired the artery and ligated the vein, with heterogeneous anticoagulation strategies. Six-month follow-up ultrasound was available in 10 of 13 patients who underwent arterial repair, showing patency rates of 5/5 (100%) for repaired arteries in the non-ligation group, and 4/5 (80%) in the ligation group. Venous patency was confirmed in 2/5 (40%) of repaired veins. CONCLUSION: Cervical ECMO cannulation carries high complication rates and heterogeneous management. All patients cannulated with a 6 Fr arterial cannula died, suggesting that an 8 Fr cannula should be used whenever technically feasible and that central ECMO should be considered when it is not.
Pediatric robotic thyroid surgery and scar-related quality of life: A retrospective cohort of 40 patients.
Airaudo O, Luscan R, Aidan P … +3 more , Simon F, Hartl D, Couloigner V
J Pediatr Surg · 2026 Jun · PMID 42349544 · Publisher ↗
CONTEXT AND OBJECTIVE: To retrospectively evaluate pediatric robotic thyroid surgery and assess postoperative satisfaction using the SCAR-Q scale. MATERIAL AND METHODS: Patients undergoing robotic thyroid surgery between...
CONTEXT AND OBJECTIVE: To retrospectively evaluate pediatric robotic thyroid surgery and assess postoperative satisfaction using the SCAR-Q scale. MATERIAL AND METHODS: Patients undergoing robotic thyroid surgery between January 2017 and December 2023 were included. Eu-TIRADS and Bethesda classification were assessed. Surgeries were performed either a transaxillary or retroauricular approach. Clinical variables and complications were recorded. Postoperative scar-related satisfaction was assessed using the validated SCAR-Q questionnaire. RESULTS: Forty patients were included, with a median age of 15 years (range: 7-18). Histology revealed 23 benign nodules, 6 multinodular goiters, 4 cases of Graves' disease and 7 differentiated carcinomas. A transaxillary approach was performed in 25 cases and a retroauricular approach in 15. Median operative time was 217 min (range: 119-347 min). Postoperative complications included seven temporary recurrent laryngeal nerve palsies, two temporary hypocalcemias, one wound dehiscence, and one temporary impairment of upper limb extension; all resolved at the last follow-up (median follow-up 31 months, range: 3-77). Thirty-one patients completed the SCAR-Q questionnaire from July 1, 2023 to September 1, 2023. Median scores were 80 for appearance (range: 17-100), 82 for symptoms (range: 47-100), and 87 for psychosocial impact (range: 0-100). Satisfaction was high overall, with a trend toward better outcomes after the transaxillary approach. CONCLUSION: Remote-access robotic thyroidectomy appears to be a feasible option in selected pediatric patients, with high cosmetic satisfaction. The transaxillary approach was associated with a trend toward higher SCAR-Q scores, although selection bias and limited sample size preclude firm conclusions regarding superiority.
Utility of Neonatal Chest X-ray in Patients with Prenatally Diagnosed Congenital Lung Malformations.
Schwab ME, Stottlemyre R, Khan FA
J Pediatr Surg · 2026 Jun · PMID 42349543 · Publisher ↗
PURPOSE: In patients with congenital lung malformations (CLM), prenatal imaging is used to risk stratify patients and delineate algorithms for delivery planning and neonatal care. Most algorithms include a chest x-ray im...
PURPOSE: In patients with congenital lung malformations (CLM), prenatal imaging is used to risk stratify patients and delineate algorithms for delivery planning and neonatal care. Most algorithms include a chest x-ray immediately after birth in all patients. This study sought to evaluate whether chest x-ray impacts clinical decision-making, ability to predict symptoms, and the decision to manage patients in the Neonatal Intensive Care Unit (NICU). METHODS: A single center, retrospective cohort study was performed of patients diagnosed prenatally with a CLM (2015 - 2025). Maternal demographics, pre- and postnatal imaging, surgical details and outcomes were collected. Patients with symptoms at birth were compared to the asymptomatic cohort. RESULTS: 124 patients were included, with a median peak Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of 0.79 (IQR 0.38-1.17). Only 15.3% received supplemental oxygen after birth (4% required mechanical ventilation). 72.3% were admitted to the NICU. 47.2% (50/106) had an abnormal x-ray, including 62% with a potential CLM and 38% with a clearly visible CLM. Of those with a clear CLM on x-ray, 84.2% (16/19) didn't have symptoms. The abnormal x-ray did not trigger further imaging or management changes. 13/19 patients with a clear CLM on x-ray were monitored in the NICU. X-ray sensitivity to detect symptomatic patients was 56.3% and specificity was 54.4%. Comparing the symptomatic and asymptomatic cohorts revealed no significant differences in the probability of an abnormal x-ray. CONCLUSIONS: Chest x-rays have poor sensitivity and specificity in the initial evaluation of asymptomatic CLM patients and did not change clinical decision-making including whether the patient required NICU-level care.
Time to Spare: 1-Minute vs 2-Minute Intercostal Nerve Cryoablation During Minimally Invasive Repair of Pectus Excavatum.
Hare R, Brierley SF, Payne R … +8 more , Khoury E, Notrica DM, McMahon LE, Bae JO, Fraser JD, Jamshidi R, McGovern P, Padilla BE
J Pediatr Surg · 2026 Jun · PMID 42342065 · Publisher ↗
BACKGROUND: Intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) reduces postoperative opioid use and hospital length of stay. However, few studies have directly evaluated opt...
BACKGROUND: Intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) reduces postoperative opioid use and hospital length of stay. However, few studies have directly evaluated optimal duration of cryoprobe application. This study compared postoperative outcomes following one-minute versus two-minute INC during MIRPE. METHODS: A single-center retrospective study was conducted on patients ≤21 years old who underwent MIRPE with INC between 2023 and 2025. Cryoablation was performed thoracoscopically for either 2 minutes per nerve using the cryoICE® cryoSPHERE+® or 1 minute per nerve using the cryoICE® cryoSPHERE® MAX probe. Demographics, operative characteristics, and postoperative outcomes were compared between groups. RESULTS: Among 164 patients, 87 (53%) received 2-minutes of INC and 77 (47%) received 1-minute of INC. Patient age, sex, BMI, and Haller Index were similar between groups. Correction Index was greater in the 2-minute group (38% vs 32%, p = 0.005). Operative time was significantly shorter in the 1-minute INC group (137 vs 170 minutes, p < 0.001). Average inpatient pain scores were slightly higher in the 1-minute INC group (3.5 vs 3.1, p < 0.05), but inpatient opioid usage was similar (0.203 vs 0.178 OME/kg). Total opioid prescriptions at discharge were lower (p<0.001) with no difference in opioid refill rates, thirty-day emergency department visits, and readmissions compared to the 2-minute INC group. CONCLUSION: Reducing INC duration from two minutes to one minute during MIRPE does not adversely affect postoperative analgesic outcomes and significantly shortens operative time. One-minute intercostal nerve cryoablation appears to provide effective analgesia.
Surgical management of abdominal tumor thrombus in children: Rethinking staging and strategy.
User İR, Ardıçlı B, Alpat Ş … +5 more , Yılmaz M, Haliloglu M, Karnak İ, Ciftci AO, Ekinci S
J Pediatr Surg · 2026 Jun · PMID 42342064 · Publisher ↗
OBJECTIVE: Inferior vena cava (IVC) tumor thrombus in pediatric abdominal malignancies presents substantial surgical challenges. We evaluated operative strategies, outcomes, and the adequacy of current thrombus classific...
OBJECTIVE: Inferior vena cava (IVC) tumor thrombus in pediatric abdominal malignancies presents substantial surgical challenges. We evaluated operative strategies, outcomes, and the adequacy of current thrombus classification systems in guiding surgical planning. METHODS: Children undergoing surgery for abdominal solid tumors with IVC thrombus over a 10-year period were retrospectively reviewed. Thrombus extent was assessed radiologically and intraoperatively, and surgical techniques and outcomes were analyzed. RESULTS: Eleven patients (median age 85 months) were included: eight with Wilms tumor, two with adrenocortical carcinoma, and one with neuroblastoma. Origin of thrombus was renal vein in 9 and adrenal vein in 2. Caudal propagation to the iliac bifurcation occurred in one patient, and contralateral renal vein involvement in two. Complete tumor and thrombus resection was achieved in all cases. En bloc resection was feasible in eight patients, whereas three required sequential thrombectomy and tumor excision to reduce hemorrhagic risk. Cavotomy with primary repair of IVC was performed in nine patients. One patient required patch repair of IVC. Another patient had segmental cavectomy. Cardiopulmonary bypass was necessary in two patients due to extensive or adherent thrombus. No major intraoperative complications or early mortality occurred. Median hospital stay was seven days, and nine patients remain in complete remission. CONCLUSION: Complete resection of IVC tumor thrombus in children is feasible with favorable outcomes. Current staging systems have limitations in reflecting surgical complexity. Other parameters like caudal extension, venous wall invasion, and degree of luminal involvement should be incorporated to better guide operative planning.
Foreign body ingestion in children: impact of a digital app on clinical decision-making.
Gigola F, Silecchia A, Parri N … +2 more , Coletta R, Morabito A
J Pediatr Surg · 2026 Jun · PMID 42342063 · Publisher ↗
BACKGROUND: Foreign Body Ingestion (FBI) is a common reason for paediatric Emergency Department (ED) visits. Although most cases resolve spontaneously, a significant proportion requires urgent intervention. Adherence to...
BACKGROUND: Foreign Body Ingestion (FBI) is a common reason for paediatric Emergency Department (ED) visits. Although most cases resolve spontaneously, a significant proportion requires urgent intervention. Adherence to standardised, evidence-based protocols is essential to prevent complications and ensure appropriate care. METHODS: This retrospective, single-centre study analysed all paediatric FBI cases over a four-year period. Demographic, clinical, and management data were retrieved and compared with international guidelines and recommendations from the Corpi Estranei mobile application, a digital decision-support tool derived from North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN) protocols. RESULTS: A total of 475 confirmed cases were identified (59.6% males). Most patients were aged 2-5 years (50.3%), and blunt objects were the most frequently ingested items (82.5%). Most children were asymptomatic (72.6%), while 26% required hospitalisation. Among admitted patients, 64.7% underwent endoscopic or surgical intervention. Interhospital transfers significantly increased hospitalisation rates; however, 37% of transfers were potentially avoidable. Fifteen cases (3.2%) deviated from guideline-based management, mainly due to unnecessary or delayed procedures or omitted imaging, most of which involved transferred patients (p < 0.05). CONCLUSIONS: Management of paediatric FBI remains heterogeneous, with frequent deviations from recommended protocols and a notable rate of avoidable transfers and procedures. This study suggests that structured decision-support algorithms may help reduce avoidable transfers and improve guideline adherence in regional paediatric networks.
Coexisting pelviureteric and vesicoureteric junction obstruction in children: Diagnostic challenges and treatment strategies - A narrative review.
Shajini N, Babu R
J Pediatr Surg · 2026 Jun · PMID 42342062 · Publisher ↗
BACKGROUND: Coexistent pelviureteric junction obstruction (PUJO) and vesicoureteric junction obstruction (VUJO) is uncommon and presents significant diagnostic and therapeutic dilemma. We conducted a narrative review to...
BACKGROUND: Coexistent pelviureteric junction obstruction (PUJO) and vesicoureteric junction obstruction (VUJO) is uncommon and presents significant diagnostic and therapeutic dilemma. We conducted a narrative review to synthesize contemporary evidence in management. METHODS: A comprehensive search of PubMed, Embase, and Cochrane databases was performed for English-language studies (2000-2024) reporting paediatric cohorts with concurrent PUJO and VUJO. Two reviewers independently screened records and extracted data regarding diagnostic strategies, initial interventions and the requirement for secondary procedures in renal-units. Risk of bias was assessed using the ROBINS-I tool. Due to the rarity of this condition and the limited number of heterogeneous studies, quantitative analysis was exploratory and focused on descriptive statistics (proportions and 95% confidence intervals) to generate hypotheses. RESULTS: Of the 734 records screened, six studies met the inclusion criteria. Significant heterogeneity was observed in preoperative imaging and intraoperative assessment protocols. Only two authors compared PUJO-first and VUJO-first management: reoperation for unaddressed distal obstruction occurred in 6/23 (26%, 95% CI: 12-47%) of former approach while repeat pyeloplasty occurred in 3/6 (50%, 95% CI: 19-81%) renal-units in later approach. CONCLUSIONS: Synchronous occurrence of PUJO and VUJO is rare and management should be individualized and sequential targeting the site with the predominant obstruction. Discordant findings between ultrasound and renogram could act as red-flag for suspecting dual obstruction. Selective intraoperative RGP is recommended in those with suspected dual obstruction. Simultaneous pyeloplasty and ureteral reimplantation in a single setting is discouraged. Further larger multi-centre studies on dual obstruction are warranted. PROSPERO REGISTRATION NUMBER: CRD420261299538.
Non-operative treatment of pectus carinatum: fifteen years of outcomes and predictors from a national paediatric service.
Dargie D, Johnstone A, Davis C
J Pediatr Surg · 2026 Jun · PMID 42336266 · Publisher ↗
BACKGROUND: Non-surgical bracing is the primary treatment for pectus carinatum, yet large cohorts with objectively measured adherence are limited. This study evaluates 15 years of bracing outcomes and identifies factors...
BACKGROUND: Non-surgical bracing is the primary treatment for pectus carinatum, yet large cohorts with objectively measured adherence are limited. This study evaluates 15 years of bracing outcomes and identifies factors associated with successful correction. METHODS: This retrospective observational cohort study included patients <20 years with chondrogladiolar pectus carinatum treated with orthotic bracing between 2010 and 2025 within the Scottish National Chest Wall Service. Chest wall flexibility was assessed subjectively prior to 2019 and objectively thereafter using a calibrated force gauge. Wear-time adherence was quantified using thermosensitive data loggers embedded within the brace. Outcomes were categorised as resolved, resolved to satisfaction, partial improvement, no improvement, lost to follow-up, or surgical referral. Associations were analysed using chi-square testing (p < 0.05). RESULTS: A total of 612 patients met inclusion criteria. Full resolution occurred in 213 patients (34.8%), with a further 73 (11.9%) achieving resolution to patient satisfaction. Chest wall flexibility was associated with outcome (subjective p < 0.001; objective p = 0.013). Wear-time adherence demonstrated the strongest association with successful correction (p < 0.001). Patient motivation was also significantly associated with outcome (p < 0.001). Age showed no statistically significant association with outcome (p = 0.10), although a trend towards improved outcomes in younger patients was observed. Laterality was not associated with outcome (p = 0.20). CONCLUSION: In this large cohort with objectively measured adherence, wear-time was the strongest predictor of successful correction, alongside chest wall flexibility and patient motivation. These findings support the importance of adherence monitoring and patient engagement in bracing programmes. Further work is required to determine optimal wear-time thresholds and to evaluate long-term outcomes following treatment. LEVEL OF EVIDENCE: Retrospective study/Level of evidence III.
Post-hepatectomy liver failure in children: Why adult surgical paradigms cannot simply be translated to pediatric surgery.
Fuchs J, Rabaux-Eygasier L
J Pediatr Surg · 2026 Jun · PMID 42336265 · Publisher ↗
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